Laparoscopic Treatment of Hepatic Abscess Induced by Foreign Body Impaling Through the Stomach - A Case Report
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2018, Vol 7, Issue 1
Abstract
Unintended ingestion of foreign body into gastrointestinal (GI) tract is not an uncommon event, and it complicates with perforation, obstruction or intra-abdominal infections in certain scenarios. The incidence of GI tract perforation developed after foreign body ingestion is less than 1% [1]. Hepatic pyogenic abscess resulting from foreign body migration is even rare [2]. Among the reported patients, most of them failed to recall the time of ingestion and the type of foreign body. The disease severity of hepatic abscess ranged from indolent chronic infection to life-threatening septic shock, but the treatment was similarly composed of adequate drainage and targeted antibiotics [3]. Regard the rare but specific spectrum of secondary hepatic abscess induced by foreign body ingestion, removal of the migrated foreign body is crucial in controlling the infection [4]. Owing to the non-specific symptoms of hepatic abscess and the difficulty in preoperative recognition of foreign body ingestion, secondary hepatic abscess remained a diagnostic challenge. The following case represents a hepatic abscess secondary to unaware gastric perforation by a fishbone that was treated by laparoscopic removal of the foreign body and percutaneous drainage of the abscess.A 63-year-old woman presented to our hospital due to fever, chillness, decreased appetite and vague epigastric pain for 3 days after returning from Netherland for sightseeing. Laboratory examination demonstrated leukocytosis, and sonography of the liver disclosed an irregular cystic lesion within the segment IV of the liver. Owing to progressive pain and persistent fever, she was referred for computed tomography (CT) scan under the diagnosis of hepatic abscess. The composed CT scan demonstrated an abscess measuring 4.3 x 2.7cm within the segment IV of the liver, in association with a foreign body measuring 2.8cm impaling from peripyloric area of the stomach (Figures 1 & 2). There was remarkable fibrotic tissue around the foreign body and space between the two impaled organs. She could not recall any episodes of fever or sharp abdominal pain during the last few weeks. Regard to the CT images, the foreign body already migrated through the gastric mucosa that endoscopic removal is not feasible. She underwent laparoscopic exploration thereafter. Marked adhesion and fibrosis between the liver and the pyloric area of the stomach was found (Figure 3A), which compatible with the preoperative CT images. The foreign body, which was a fishbone, was removed after meticulous dissection along the fibrotic tissue (Figure 3B), and the impaled site on the stomach was repaired with interrupted sutures and omentum patch (Figure 3C). Concerning the spillage of abscess into peritoneal cavity by concomitant surgical drainage, we applied a pigtail into the abscess via percutaneous fashion (Figure 3D). The bacterial culture from the abscess yielded Klebsiella pneumonia, Streptococcus anginosus, and Actinomyces odontolyticus, which were eradicated by targeted antibiotics for 5 days. She resumed oral intake since postoperative day 5 and was discharged on postoperative day 8 after removal of the drainage for the abscess.
Authors and Affiliations
Chun Yi Tsai, Pei Ching Huang, Wen Hui Chan, Chun Nan Yeh
Keywords
Related Articles
- EP ID EP588522
- DOI 10.26717/BJSTR.2018.07.001454
- Views 193
- Downloads 0
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